Provider Demographics
NPI:1962581884
Name:LRGHEALTHCARE
Entity type:Organization
Organization Name:LRGHEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EVP-CFO
Authorized Official - Phone:603-524-3211
Mailing Address - Street 1:PO BOX 4144
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01888-4144
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:
Practice Address - Street 1:15 AIKEN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-1259
Practice Address - Country:US
Practice Address - Phone:603-524-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LRGHEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-02
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02896207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHFRAN991297OtherANTHEM
NHFRAN111300OtherANTHEM
NH556210OtherCIGNA
NHFRAN991288OtherANTHEM
NH30212032Medicaid
NHRE6725Medicare ID - Type Unspecified